Individual
JACOB THOMAS LUTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-8211
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-8211
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
MD176683
OR
Other
Enumeration date
03/27/2013
Last updated
06/20/2017
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